Abstract

Hepatocellular carcinoma is the sixth most common cancer and the third leading cause of cancer-ralated death. TACE is an effective option for patients with intermediate HCC. Although conventional TACE with administration of a Lipiodo-anticancer emulsion followed by embolic agents has been most popular technique, the recent introduction of embolic DEB has provided a valuable alternative. The DEB is a novel drug delivery embolization system that hea been designed to deliver a higher and more sustained release of drug directly into the tumor and a low release of drug into the systemic circulation, with the intention to maximize the drug effectiveness in terms of response, while significantly reducing its systemic toxicity. Obtaining a triple-phase CT or MRI imaging of the liver is required to integrate clinical and laboratory data to evaluate the indication to TACE with DEB and additional imaging to exclude extrahepatic disease should be performed as pretreatment imaging. Obtaining a CT or MRI imaging 2-4 weeks after TACE is recommend to assess tumor response and to decide the further plan. The use of modified Response Evaluation Criteria in Solid Tumors (mRECIST) for HCC is recommended for response Classification. We offer our experience of a patient with atypical finindg on follow-up CT after DEB TACE. Marginal recurrence or residual viable tumor was suspected on CT 4 weeks after DEB TACE but disappeared on CT 10 weeks after treatment. There was no evidence of recurrence or residual tumor in TACE site and its margin 12 weeks after TACE. We thought that it was attributed to the benign change as AV shunt or to the characteristics of DEB which has been designed to deliver slowly, higher and more sustained release of drug directly into the tumor. But further study is necessary on how long the drug delivery from DEB to tumor is sustained and when the appropriate tumor response is accomplished after treatment.

• Keywords: Hepatocellular carcinoma;Drug-eluting beads;Chemoembolization